The surprising reasons heart patients don’t go to cardiac rehab

by Carolyn Thomas   @HeartSisters

Cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic in Rochester, Minnesota, has this important advice for all heart patients:

 “If your doctor recommends cardiac rehabilitation, go. 

“If you’re not referred, ask.

“And if you ask, and are told ‘You don’t need it’ – find a new cardiologist!”

Based on what we already know about the shockingly low rates of physician referral to this life-saving treatment (as low as 20% of all eligible heart patients) we might expect a flurry of doctor dumping if heart patients follow Dr. Sharonne’s advice to seek out physicians who are more appropriately informed.  

According to The American College of Cardiology (ACC):

“Women with coronary artery disease who completed a 12-week cardiac rehabilitation program were two-thirds less likely to die compared to those who were NOT referred to the program.

“In addition, the mortality benefits of this evidence-based program derived for patients with angina, or for those recovering from heart attack, coronary artery bypass graft or implanted stents appear to be much more striking in women than in men with the same condition, yet referrals and attendance among women fall short.”

So why aren’t all cardiologists recommending this evidence-based treatment program to their patients with the same enthusiasm they’re mustering to recommend a fistful of cardiac drugs to every survivor?

As I’ve written here:

Doctors themselves are a significant obstacle to cardiac rehabilitation participation, as described in this American Heart Association report published in the journal Circulation(1):

“Given the well-documented benefits of participation in cardiac rehabilitation, it is surprising how few eligible patients are referred to rehab. A number of recent surveys have reported referral rates in the order of 20%.(2, 3) The under-utilization of cardiac rehab is particularly apparent:

  • in women
  • in those with low socioeconomic status
  • in African-Americans
  • in the elderly

“Each of these groups represents those who are significantly more likely to die within five years following a first heart attack.(4)”

As the ACC report explains, even a brief endorsement of cardiac rehabilitation by a physician has been shown to improve patient participation in this important exercise/education follow-up program. In fact, physician endorsement is one of the strongest predictors of full participation in cardiac rehabilitation.

PLEASE NOTE, Doctors: checking off a little tickbox on a discharge form or clicking a button on a computer screen is NOT an endorsement. An endorsement is taking 11 seconds to say something like this out loud to your patient:

“Cardiac rehabilitation is a terrific program for heart patients that has been proven to improve quality of life and reduce your risk of having another cardiac event – and I’d really love you to participate in this program.”

Dr. Gina Lundberg, a Preventive Cardiologist & Clinical Director of the Emory Women’s Heart Center in Atlanta, tweeted this message to her colleagues: 

“Women go to Cardiac Rehab when I encourage them. Many MDs don’t encourage women to attend. MD bias problem!”

Her Tweet was aimed at her like-minded colleagues Dr. Sarah Samaan and Dr. John Erwin III, both Texas cardiologists who seem equally keen on getting more heart patients to experience the lifesaving benefits of cardiac rehab therapy.

Their ongoing online discussion topic: why do so few heart patients participate in a cardiac rehabilitation program? (Their secondary discussion topic: Do we need to change the name of cardiac rehab?)

We know that physicians’ failure to refer is a major (and utterly preventable) reason. As I quoted him here, Oregon cardiologist Dr. James Beckerman is blunt in his assessment of such failure:

It is bad medicine to withhold life-saving treatments, and many physicians are selling their patients short.”

And if Dr. Gina herself can somehow convince her own heart patients to attend cardiac rehabilitation, what possible excuse can there be for all those physicians who are NOT referring 80% of all eligible heart patients? 

But we know that there are also other practical issues that discourage cardiac rehab participation. A number of researchers have investigated why women in particular are not only less likely to attend, but also more likely to become rehab dropouts compared to our male counterparts. Reasons include:

  • cost
  • unavailable or unaffordable child care
  • can’t get time off work
  • transportation issues
  • no evening/weekend programs available
  • reluctance to exercise in front of men
  • lack of awareness of rehab program’s benefits

But a physician’s failure to refer in the first place should never be the reason that any eligible heart patient doesn’t go to cardiac rehabilitation. See also: Why aren’t women heart attack survivors showing up for cardiac rehab?

But here are some examples from Real Live Patients who shared their own experiences with (or sadly, without!) cardiac rehabilitation:

    “I so wish I had had rehab. I went to the introductory meeting and the therapists told me that all patients had to be referred by their doctor. My doctor refused to refer me, saying it would not do me any good, and was angry that the therapists had told me it would be helpful. I begged for a referral, saying I would pay out-of-pocket, but he still refused.”  (heart attack, sudden cardiac arrest, ICD implanted)

♥   “My cardiologist did not even suggest it, they did not talk about it at the hospital. I found out about it from a relative, asked for a referral and my cardiologist said ‘Fine, but I think it is a waste of time personally.’ “(heart attack)

♥   “I was referred to cardiac rehab, however my insurance would not cover it so I only went a few times. I found this to be so odd because my bill from my STEMI (heart attack) was about $250,000.  That they would cover this and not the recovery and prevention of the next one leaves me scratching my head.  I work managing medical billing so I am not sure why this was so surprising to me but it was. With all of the studies surrounding the benefits of cardiac rehab, it just seems so ridiculous.” (heart attack)

♥   “I did not get to go. I asked my cardiologist and it was covered through my insurance, but he said to just exercise and eat a balanced diet. I later asked him why he refused to send me, and he said it was because of my age; they had no one else going at the time under 70 and he was afraid it would cause further depression. I knew 47 was young to have a heart attack. I think it would have helped me immensely with the fear.” (heart attack)

♥  “Some doctors are negative and think cardiac rehabilitation is not needed. It amazes me that any cardiologist would discourage anyone from 12 weeks of cardiac rehab if you are eligible. For those who have been discouraged, find a new doctor who is aware of the importance of cardiac rehab. There is no room for ego in participating or encouraging someone to do something to increase their physical and emotional well-being.” (heart attack, SCAD*)

♥  “Not everyone has insurance which covers cardiac rehab. Some people have insurance which can only partially cover it, and even that can be steep. For myself, the rehab was $150 per session, and my insurance covered $100 of that cost. For 36 sessions, it cost me $1,800. Thank goodness I could afford it, but it was a shocking amount of money, especially after the cost of my hospitalization/heart attack. But in the U.S., only those with decent health plans will be able to attend cardiac rehab, it really is a therapy for the haves versus the have-nots. For me, worth every single cent I paid. It was my oasis in a time of fear. I regained my confidence in my body and in my health while at rehab.” (heart attack)

   “I would love to attend cardiac rehab, but trying to work full-time and having so many doctor appointments, there is no time left. My job is already in jeopardy because of being off work so much. Cardiac rehab is 3 times a week for 10 weeks and it is all during work hours. I wish they had more convenient hours for people who have to work 8 to 5. I know my heart is important, but if I don’t have my job I couldn’t pay for the cardiac rehab. Vicious circle.” (heart attack)

♥   “My doc is 70 years old. He told me he reads every night to keep up on the latest information, so I don’t think exercise or cardiac rehab is a big mystery to any doctor in this day and age.  I think (doctors’ reluctance to refer) might be stubbornness or fear of change. Unfortunately this harms women. I started cardiac rehab 18 days after my SCAD, cardiac arrest, and four stents – five days in the hospital. I now go three times a week.” (heart attack, SCAD*, cardiac arrest, four stents)

    “Where does doctors’ bias against cardiac rehab come from? I think arrogance, actually. Cardiologists sometimes think that it is all about them, that they are fixing you, you do not need the other stuff. They think cardiac rehab is some kind of fluffy do-good yoga and meditation program rather than a serious educational and exercise program designed to give heart patients a better chance at avoiding a repeat. Honestly, I think sometimes they believe you just need the office visits, the meds and you are good to go.” (three heart attacks)

♥   “I only attended for about six sessions. It was good, but I had to pay $60 for each session and find a babysitter each time I went, so I had to stop because I couldn’t afford it.” (SCAD*)

   “If doctors aren’t ‘prescribing’ cardiac rehab for those who need it, how would the patient ever know about it?” (sudden cardiac arrest)

   “I think cardiologists and other healthcare providers still need to be educated, or educate themselves about the benefits of cardiac rehabilitation. Then perhaps they will properly educate and motivate their patients to attend. Lastly, the nurses and others who actually run the programs must educate patients to make the necessary decisions to make time for their own recovery and not drop out of the programs.” (coronary artery disease, stents)

   “I did cardiac rehab for about four weeks and checked myself out. It was BORING! I am a fitness instructor so even though my insurance was paying for it, I knew I could do what they were doing at my own gym and be with my friends and people my own age.” (sudden cardiac arrest)

    “Cardiac rehab would have been such a help after my difficult recovery. I slept in a chair for 5 months because of lung complications. I had difficulty breathing and could barely walk. It was a long road back and I was scared to death.” (aortic valve surgery)

    Went to rehab for only a few weeks before I quit. It turned out to be an Old Boys Club. VERY disappointing.  I was the only woman there, much younger than anybody else (in my early 40s) and some of the men in my group were in their 80s! I was still working, had young kids at home, stressed out about how on earth I was ever going to manage going back to work, raising my boys, running a household again, all while coping with this scary angina pain. Wish our rehab program had included more than just exercise but also help with the emotional pain too. I’ve also heard about woman-only cardiac rehab groups, would have LOVED that.” (coronary microvascular disease)

   “From personal experience, I was NOT one of those patients who ever received a referral. I even asked my cardiologist to refer me to rehab so I could get stronger. Nope. He wouldn’t do it for whatever reason.”  (heart attack)

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* SCAD = Spontaneous Coronary Artery Dissection

.Thanks to all of my heart sisters who took the time to share their experiences!

NOTE FROM CAROLYN:   I wrote much more about cardiac rehabilitation and other ways to improve  your chances of survival in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the JHUP code HTWN to save 20% off the list price).

 

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(1) Arena, R et al. Increasing referral and participation rates to outpatient cardiac rehabilitation: the valuable role of healthcare professionals in the inpatient and home health settings. A Science Advisory From the American Heart Association. Circulation. January 30, 2012

(2) Suaya JA, Shepard DS, Normand SL, et al. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation 2007;116:1653-1662

(3) Boyden T et al. Can increasing referral to cardiac rehabilitation improve participation? Prev Cardiol 2010;13:198-202

(4) Roger VL, et al., on behalf of the American Heart Association Statistics Committee and Stroke Statistics Committee. Heart disease and stroke statistics – 2011 update. a report from the American Heart Association. Circulation 2011;123:e18-e209

Q:  If you’re a heart patient who did not attend or complete a supervised cardiac rehabilitation program, tell us why

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See also:

Do we need to change the name of cardiac rehab?

Failure to refer: why are doctors ignoring cardiac rehab?

‘Women-only’ cardiac rehabilitation curbs depression for heart attack survivors

Why aren’t women heart attack survivors showing up for cardiac rehab?

Study: “91% discharged from hospital without care plan”

I was interviewed for this US News article: Cardiac Rehab: Boosting Your Heart Recovery

Returning to Exercise (and Training) After Heart Surgery (THE best and most comprehensive overview on this topic I’ve seen yet, written by cardiologist and triathlete Dr. Larry Creswell; especially useful for heart patients who have been physically active  before their cardiac event and are wondering how to safely resume their routine)

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100 thoughts on “The surprising reasons heart patients don’t go to cardiac rehab

  1. Pingback: The Heart Source
  2. Fortunately, my Cardiologist is a big supporter of cardiac rehabilitation. I am on Medicare and they paid for 36 visits in full. I received so much benefit from it that I continue to go as a paying patient. The place I go charges $50 a month for two times a month and $60 for three times a month. Well worth the money. I like going here instead of a gym because it is in a hospital setting and I am still being monitored.

    Liked by 1 person

  3. I wish I could go. I had my Heart Attack a month ago. They said my insurance will not pay for it. I called the Insurance company and was basically begging to get them to cover it. I explained I’m disabled and cannot afford the $150 per session cost. Their response was, and I quote, “Well, we’re sorry but that is why you need to take care of yourself!”

    Hmm, ok. Because I asked to be born into the gene-pool of heart disease that has literally killed my Dad’s entire family. Nor did I ask for a diabetic gene. While lifestyle didn’t help, (smoking, overeating) I had just had a stress test done a couple years ago and was in great shape.

    Still. Doesn’t make any sense why they are okay paying $25,0000 for a heart attack but will not cover the $3,800 for the rehab program. Makes no sense. I won’t let it stop me. As much as I detest the internet Ill take advantage of it and create my own cardiac rehab and I will succeed. Can’t let the ignorance that is the Health Insurance world stop me from living, and living a long life at that!

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    1. I agree, Kevin – it makes no sense at all to pay for expensive interventional procedures, but not for the proven cardioprotective benefits of cardiac rehab! There’s a reason cardiac rehab is called “cheap life insurance” – at any cost. My own (otherwise excellent) extended health benefits also did not cover any of my cardiac rehab. In fact, we even sent an appeal letter directly to the Blue Cross health insurance headquarters (denied!) – so I scrambled to find the money and paid for all of it myself (I too was on a very modest disability pension). It goes without saying that I’m hoping your renewed goal to “live a long life” now includes no more “smoking, overeating”. We can only blame genes for so much…

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  4. I think it’s a mistake to think cardio rehab is the cause of people surviving longer who go vs those who don’t go. I would be looking at the people who don’t go and probably seeing things like lack of funds for healthier lifestyles or basic medical care, a lot of stress, a habit of putting one’s own needs behind those of others, etc, any of which would likely contribute to increased possibility of death. For myself, I went to CR and wasn’t bothered by being the only woman and decades younger than the youngest man (56 for the first half) – they were super supportive and very nice. But I didn’t find the exercise particularly useful. It was sorta fun to do the treadmill and elliptical, but I walk every day anyway. The eductation was kindergarten-level and I was already self-educated to at least high school graduate on the heart stuff. However, the camaraderie of the men and the amazing emotional support from the nurse and her assistant kept me going. I have no friends or family capable of giving me the kind of emotional support that I would like to have.

    Liked by 1 person

    1. All good points, Holly. That “emotional support” you found so helpful should not be underestimated as a key factor among the proven and unique benefits of attending (and completing!) a cardiac rehab program.

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  5. I have not been to the rehab yet. My doctor is referring me to one and checking on the insurance. I didn’t even know they had them until my Dr told me about it. I am looking forward to going to get the help that I need to get me going best that I can and to lose these unwanted pounds of weight I’m carrying around. Eating right to help lose also. And as far as men or women or age, it doesn’t matter. I am going to better myself and in so doing may help someone right beside me to do the same. Thanks to my Dr for speaking to me about this.
    Thanks,
    Phyllis

    Liked by 1 person

  6. It matters where you receive cardiac rehabilitation. Staff being “nice” to you, doesn’t cut it. Every cardiac rehabilitation patient should have a complete examination by a cardiac physical therapy specialist. Otherwise, patients can get hooked up to monitors and put on machines to do exercises that are potentially harmful to them. Many weeks now, into my own cardiac rehabilitation, (non-event-rehab), I continue to see new patients arrive and be put on equipment without this necessary physical capability assessment. They are asked if THEY feel okay on the equipment. Of course, they say they do, even when they don’t, because, after all, if they say they aren’t doing okay, all that will happen is that they’ll be told to slow down on the equipment, or move to a different piece of equipment. A physical education gym teacher wouldn’t do this.

    People have other physical difficulties then their heart. Not taking this into full consideration is of great detriment. (Yes. I have spoken repeatedly to the administrators about this problem, to no avail).

    Please demand as much quality from cardiac rehabilitation services as you are putting into saving your life.

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    1. Hello Jane – I’m not quite sure if what you’re describing is that different than what happens in many (most?) programs. In my own rehab program, each participant met individually with the program leaders for an official assessment (both cardiac and overall physical suitability) before showing up for Day One of the actual program. Thus the only people who then do show up on Day One post-cardiac event were those who had been professionally evaluated first. (Personally, my own registration was delayed for one full month because at the time, I was unable to “pass” that first screening exam for a number of reasons). And I too was occasionally told to “slow down” or “change equipment” when appropriate – that’s what supervised monitoring is for (and we had a number of elderly participants well into their 80s, each working at their own appropriate speeds, some days harder, some days not so hard). In my experience, cardiac rehab participants are remarkably open about indicating what they are able or not able to do on any given day – not one was shy about saying they “weren’t okay”.

      It almost sounds like you’re saying you’ve witnessed people being pushed into doing dangerous activities. If you do have evidence of dangerous practices observed in your program (or in any health care setting), consider sending concerns in writing rather than just speaking to administrators.

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  7. My husband has had 3 cardiac events (heart attacks) the last time he survived the widow maker. He did not go to rehab because they wanted him to go 3 times a week and our copay was $25 a visit. We simply could not afford $300 out of our income for it. I don’t understand why an insurance company will shell out 60 to 70 thousand dollars but not fully cover cardiac rehabilitation. He still suffers with PTSD from the last one. That heart attack lasted over 2 hours from onset to treatment. He never passed out so he suffered significant pain, which resulted in the PTSD. He has panic attacks when he feels even the slightest change. It’s awful and Blue Cross Blue Shield doesn’t even care. He can’t get treatment for the PTSD either for the same reasons. Our copay for psych is $35 a visit (specialist) and the counselor said he needs to come 2 or 3 times a week to start out.

    This is what gets my goat about the ACA. It is a misnomer. All we have now is tons of people paying for insurance coverage that they cannot afford to use, just like me and my husband, we have coverage, but even with the coverage we cannot afford the care.

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  8. My 2nd round of Cardio Rehab possibly saved my life. Because of being monitored during Rehab we learned my heart rate soars when I walk, so a Holter Monitor was ordered. The Holter revealed frequent episodes of dangerous HR, including while I was sleeping. (I don’t have symptoms so don’t know when my heart is racing).

    So we are now working to get my HR under control. And, since Round 2 will end soon, I have requested to be approved for a THIRD round of Rehab (it is not safe for me to “graduate” to the unmonitored level because of my uncontrolled HR).

    Obviously I urge everyone to go to Rehab!

    Liked by 1 person

    1. I have now been in Cardio Rehab for several years. (Still fully monitored due to my crazy but asymptomatic AFIB w RVR HR.) Where I haven’t been is rehospitalized! 🙂

      My CHF and cardiomyopathy have improved greatly – my EF is >50 and my heart is now normal size, all this in spite of permanent AFIB w RVR.

      Due to my participation in Rehab we have even been able to improve my rate control since the Rehab nurses send session reports to my cardiologist (several hours drive away).

      I used to be the only woman. The occasional woman who would come rarely finished the full 36 sessions. I am happy to say that is improving – we have more women and they usually complete the course now.

      I am a strong proponent of Cardio Rehab. I think Cardio Rehab and addressing my sleep issues are each huge factors in my recovery.

      Liked by 1 person

    1. Thanks Dr. H – 2/3 actually sounds pretty impressive compared to where I live! There are indeed many practical real-life reasons patients stop attending (and sadly, women are more likely than men to become cardiac rehab dropouts!)

      I’m wondering what “everyone gets referred” means. Where I live, I’m told the same thing – but what it actually means here is that a little box on the discharge form is ticked – a piece of paper that few patients actually see.

      Research suggests that physician endorsement is the main predictor of both attendance and completion. But “physician endorsement” is not the same as ticking off a box on a sheet of complicated hospital info, but saying out loud a simple statement like: “It’s very important that you attend Cardiac Rehabilitation because it’s been proven to save lives – here’s more info on how to register!” – which takes about 10 seconds to say out loud before a patient is discharged. There will always be those who genuinely can’t attend for personal reasons – but one of those reasons should never include “my doctor never mentioned it…” or (worse! as some of these women heard: “You don’t need it!”)

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  9. I started cardiac rehab in May 2014 after a SCAD, MI, and cardiac arrest resulting in 4 stents in my RCA on April Fool’s Day. My cardio (God bless this smart man) runs his own rehab at his practice. After the 12 weeks there, I have continued 3x a week at a facility closer to my home. Since I started, I have only missed 4x. I enjoy it and it makes me exercise.

    My doc says it is the most important thing I can do after taking my meds. He believes in getting his patients up and moving ASAP under close scrutiny and with necessary adaptations for various conditions.

    Liked by 1 person

  10. Well, the next time I have a heart attack I’ll know to ask. I had the worst cardiologist…ever. He yelled at me for not taking aspirin, even though the nurse in the hospital didn’t write it on my list. Ugh.

    Liked by 1 person

  11. This is a timely article for me. I attended Cardiac Rehab after stents three times in 2005-2007. Finally finished the last time. It was a very good program, and I found that the size of the program ensured that there were other females in the group.

    The major factor in my not continuing both first and second times was PAIN. The first time, I was diagnosed with fibromyalgia, and the second time I had to quit suddenly because of an attack of Polymyalgia Rheumatica. I began again in 2014 after two new stents. Once again, I quit because of pain.

    I am now eligible again after an NSTEMI and stents. The plan is to go through physical therapy to get me to where I can begin Cardiac Rehab. I am considering staying in the Fitness Forever program where I can use the machines at physical therapy at my own pace, thinking that the reason for precious “fails” was too fast ramping. We’ll see.

    Liked by 1 person

      1. I never made it to Cardiac Rehab this time. Physical Therapy brought out severe knee, foot, and hip pain which left me shockingly disabled for a time. It looks like I am left with lovely memories of the times I did go in the past. Something I need to accept after all this time.

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  12. One of my fondest memories was from my Cardiac Rehab experience. On the first day, I was nervous but confident that I could do the “work”. I was the only person there under retirement age, but everyone was nice and the staff was amazing. They offered lots of education throughout the course of the 12 weeks.

    But my “funny” memory was from the very first day when I noticed that the music track playing overhead was all disco. For whatever reason, I found this hilarious watching these seniors grooving to “I Will Survive” and “Staying Alive”. It was surreal but no one seemed to notice the irony but me. All in all, it was a great experience that I would (and do) recommend.

    Liked by 1 person

  13. I had to request rehab but when I did my Cardio was very supportive. (I learned about it from an online CHF support group.) It still took months to actually happen as the insurance company and my PCP dragged their heels. When it finally came through it was for 16 visits (it is normally a 36 session program). It took several weeks AFTER those initial sessions were completed for approval to complete the program, meaning I lost the progress I had made when I was able to return.

    Yes, I am usually the only woman and yes, the men are a couple decades older than I am but they’re sweet so I just listen to their WWII/Korean war stories with each other as I do my exercises.

    Three sessions a week has been difficult for me. I have so much fatigue – everything leaves me tired, including Rehab. I end up never having an entire day at home between Rehab and work (I work weekends as well as during the week). I wish I could go twice a week (M & Th or Tues & F) but it is a MWF program.

    I don’t like the name. As my son teased me, “Rehab” has come to mean drugs in today’s world so saying anything about Rehab raises eyebrows/causes confusion. I usually just refer to it as Physical Therapy.

    An all female session would be wonderful – or even one aimed at CHF since it isn’t the same for the other heart patients.

    Rehab did SO much for me! I don’t have pain and I don’t usually know when my heart is racing so it is hard for me to know what is safe for me and what isn’t. I had to really push for the feedback I needed but once I did the RNs started telling me my heart rate with each exercise and each cool down walk (my HR soars when I walk). In time, I began to have a better idea of what a high HR feels like (some of the time).

    I am now fighting to have another 36 session program approved. My Rehab has never had this request before but they are supporting me in this because my HR goes so high and because I am not usually aware of it which means it is not safe for me to “graduate” into the minimally monitored portion of Rehab offered to others (if they can afford to self pay, which will be a hardship for me).

    Liked by 1 person

    1. So many important points in your comment, Jean – thanks for this. The preventable barriers to participation started early, for example: you had to request a referral yourself, your PCP “dragged their heels”, insurance approval for only 16 weeks instead of 36. It simply should not be this hard to access a proven program that improves cardiac outcomes! Best of luck in getting approval for an extension.

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        1. Congratulations! I’m glad you have this celebration under your belt! It’s great to get what you deserve and have paid premiums for from your insurance.

          Elizabeth Y. RN, BSN

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  14. I participated in cardiac rehab in 2011, following heart failure, cardiomyopathy, pacemaker, etc. I found it extremely helpful and supportive. The staff was friendly and supportive, as were the other patients. An excellent program.

    Liked by 1 person

  15. Last Friday I started rehab for my fractured arm (wrist). My orthopedic surgeon referred me. I now have a plate with screws in my arm and my therapist tells me that it is safe to exercise my hand even though it is painful.

    After having breast cancer, my oncologist office told me about The Wellness Community. It is free.

    My arm surgery and lumpectomy were outpatient surgery. I was in the hospital for eight nights after my valve replacement surgery and I was NOT referred to cardiac rehab. For the last twenty years, I have always been told that if I cannot say three words that I am exercising too hard. Many times when I have hiked with my family I have sat on a rock while they have hiked to the top of a trail. I wish I had a cardio therapist to tell me what my safe range was for exercising. I am also getting a CT every year to monitor my aneurysm and my valve is leaking again.

    Liked by 1 person

    1. Ouch! Seeing these two follow-up health care issues so routinely addressed by other health care teams really accentuates the failure of cardiology to do the same, doesn’t it? Rebecca, I’m thinking that it’s never too late to consult a cardiac therapist/kinesiologist to answer your questions about your exercise capacity. Please ask around – as Kathi’s comment confirms (below, “Accidental Amazon”), even if you don’t have a cardiac rehab program nearby, a physiotherapist referral might be a good idea. Ask your cardiologist. Best of luck to you…

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  16. Wow, Carolyn!! First of all, I have to say that one of the respondents you quoted raised a good point: it would be really helpful if cardiac rehab programs offered evening hours for people who are working. And it’s crazy that some insurance plans don’t cover it.

    But I’m just amazed that so many cardiologists don’t refer! How can we change that, I wonder? I will mention again, though, as I have in a previous post comment, that people can ask any of their docs, not just their cardiologist, to refer them for homecare nursing & physiotherapy after a cardiac event of any sort, which can really help prepare & guide a person — and their doctor — toward a referral for outpatient cardiac rehab.

    It would be nice if patients didn’t have to ask, but even if they don’t make it to an outpatient program, home physiotherapy can teach them a lot.

    Another great post.
    Kathi

    Liked by 1 person

    1. Thanks Kathi – we have the same problem here (no evening/weekend rehab hours for those who are working, or for those who would benefit from these hours so they don’t have to arrange/pay for babysitters). Often it’s simply a case of using program staff who are working days, rather than pay for overtime. I’ve mentioned it locally a number of times to staff at these programs, always with the same anemic reaction: “Oh yeah…. we’ve been thinking of doing that…” I’m also wondering if encouraging heart patients to arrange for home care nursing/physio visits as a routine practice might be a wise recommendation. You’re so right, patients shouldn’t HAVE to be the ones to plan for such arrangements to fill the gap left by referral failures, especially during an overwhelmingly stressful time – but they do!

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      1. I have no doubt that everything is still geared to – men. I am to start cardiac rehab on Wednesday, and my problem is that I will be the only person there who has not had an MI, nor any intervention – because the cardiologists changed their minds and – never mind.

        Going to cardiac rehab in the past hurt me both physically and psychologically. Why go this time – even once? Well, they tell me there is evidence of severe LAD obstruction – which is a different story, and I’m frightened. And yet, if going to rehab hurts me physically and emotionally, what’s the point.

        It’s not as though they have set up a program for people who have not had events. It’s not as though they have changed the equipment in the last 7 years, so that it is not all set up to suit a male physique. Yet the hospital has spent loads on physical plant “improvements.”

        Ah well. I’ll go the one time. It is the only way I can get a repeat exercise EKG because the cardiologists refuse to do it. Why they are refusing, given there were electrical problems with the equipment – is also beyond me, and I apologize for writing about it, yet again.

        Lucky for me, mail wasn’t delivered today, which means I have one more day of freedom from reading the two cardiologists’ “indictment” (which should just be standard, but thorough reports, but won’t be), and having nausea from reading all the inaccuracies. Maybe I should just rip it up and throw it away.

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        1. Jane, the one truly positive message I can take from your comment is your willingness to go to cardiac rehab just “the one time”. That’s a great start, really. Many people are simply never referred by their physicians in the first place, or if they are, they don’t bother showing up. And you will get a repeat exercise EKG, also good. As you know, doing ANY kind of supervised exercise is a good thing for your heart whether you’ve had a heart attack/intervention or not. (People living with heart failure who have had neither an MI nor an intervention benefit from cardiac rehab, for instance). You could go with an open mind expecting that this time your experience just might be better, or you could go with your mind already made up that Wednesday’s session will “hurt you both physically and psychologically” (not sure what that means) – but my guess is the former decision just might turn out to be a more useful tool for your future. It’s a free country, your choice – best of luck to you…

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          1. The 4th time was a charm, but more like the evil eye. I approached the four sessions with optimism, that this rehab program would have changed in quality in 7-years’ time. It hasn’t. There is one nurse who will not even look at me. She didn’t like me before, and she doesn’t now. This is real. She takes offense if there are questions related to her ‘education’ sessions. What we have here is dedicated status quo, and you can’t solely blame hospital administration for it because – well, yes you can; there is no oversight, no evaluation of the ‘program’. I’ll tell you what it is – the nurses aren’t interested in the aspects of cardiac rehabilitation. Lack of interest.

            While they will read the monitors, and take your blood pressure, there isn’t one word uttered that indicates they have read one new thing in all this time. They’re doing a minimal, status quo job. Yes. I am angry. With any job, if you’re not constantly learning and then applying what you have learned to your work, then you’re going through the motions. In this case, it’s critical not to do that.

            I’m sorry that you do not understand “hurt physically and psychologically.” Physical pain due to ignoring physical problems of patients, and having them proceed on equipment, and with movements that will hurt them. (This isn’t all about me; I see it). Psychologically? The nurse-who-hates-me because I don’t just swoon when she says blatantly incorrect things, and the general sense that it’s a competition, instead of a place of wellness.

            It’s far more a situation where you’d best be on your best behavior. Where “RN” has only the most superficial meaning. I’ll go today because the focused exercise on the treadmill is good for me. But what they’re doing there is so sub-par in terms of what should be and could be done, is wrong. The next group that studies non-compliance in cardiac rehabilitation should interview the people who have left the program.

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  17. The rehab program I attended in 2013 required a 12 week 2x per week commitment. Those were the terms under which Medicare would cover it. I went for 8 weeks but stopped going when the snow & ice got to be an enormous hurdle.

    When I wanted to resume in the spring of 2014, I learned that I would need a recent nuclear stress test. (I have a mobility impairment). A nuclear stress test would take 4 to 5 hours & the thought of spending that much time in a lab setting was a deal breaker. I know I should just “do it” because I have seen the benefits firsthand. In 2015, now that the weather is thawing out, I will stop resisting & go ahead with the stress test.

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  18. A question: What should a good “cardiac rehab” program ideally look like?

    (I didn’t go to a formal program, despite being automatically referred (all expenses paid) on leaving hospital, as my GP was concerned about a ventricular clot and the triple blood thinning regimen I was on at the time. I did – and still do – walk on a daily basis, however. Two and a half years later, I’m wondering what I missed.)

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    1. Hi Judy – if you were (and still are) able to walk every day, you quite likely could have handled cardiac rehab just fine (plus you would have been monitored throughout each session to make sure you were). Cardiac rehab programs differ from city to city depending on facilities/staffing available, but the programs that demonstrate superior outcomes are those with both supervised exercise as well as an educational/psychosocial support components. Most however concentrate on supervised physical exercise only. Dr. Chris Blanchard at Dalhousie found in his research that “women find programs more appealing if there is a strong psychological emphasis, rather than exercise being the main focus, as is currently the case.” But even exercise-only programs are better than not going at all.

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      1. Thanks, Carolyn. I did go to the educational/psychosocial support part of the program, before my GP intervened, and found that part alone beneficial, if only because I was already doing most of what was recommended. I live in Winnipeg, Manitoba, and our province picks up all the costs for the six-week cardiac program here – I take it we’re very lucky on that score alone. Still think I missed out on the exercise component – oh, well.

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        1. Manitobans are indeed lucky to have cardiac rehab funded! Here in BC, I paid about $400 cash for my program. I also applied to my Extended Health coverage through work (it covers services like massage, acupuncture, physiotherapy, medications, dental) but they replied that cardiac rehab was “not an eligible expense”. Ironic given published outcome benefits and that we need a cardiologist’s ‘prescription’ to attend…

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  19. Hi Carolyn!

    I stopped going after 2 weeks because my “youth and ability were upsetting other patients.” Since the rehab staff didn’t believe I was sick, I didn’t really qualify. It would have been much better had they been more supportive of my mental state.

    BTW – talk about PTSD, I am in my 4th month of back to work and have been working in a mid-sized medical center here managing construction. The first few times I was in the Emergency Department, the smells and sounds got me ALL choked up even as I was in meetings about moving walls and matching flooring. It still can catch me off guard !

    Liked by 1 person

    1. What? Whaaaat? You were “upsetting other patients”? Everybody participates at their own pace and ability, and a good rehab program supervisor knows that. Responses like that merely reinforce the stereotypes of who does and should attend rehab programs. Thanks for that reminder about PTSD – those surprising symptoms can creep in when least expected. Interesting research recently about late-onset PTSD among Vietnam war vets who have shown no signs of PTSD for decades, but start to now that so many are reaching retirement age. The Vietnam Vets of America Health Council told the military journal Stars and Stripes in June of 2012: “A lot of people coped with the traumatic experiences in war by throwing themselves into work when they got home.”

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        1. Ha! That’s so great, JG. Have you seen this amazing video from the late architect/designer Michael Graves (who completely rethought hospital room design after he became a paraplegic)? It’s about 42 minutes long, but I think you’d appreciate it…

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